Attempts have been made to use Er:YAG laser sclerostomy, in which the channel is ablated through the sclera (see Fig. It can be assumed, therefore, that a certain degree of thermal change is inevitable with use of erbium lasers for treating mineralized tissues, even when the operating field is irrigated with water. 3.3), this laser is potentially very useful in surgery. Mary Lynn Smith RDH, in Principles and Practice of Laser Dentistry, 2011, Erbium lasers are FDA cleared for both hard and soft tissue applications, and some Er lasers are FDA cleared for sulcular debridement. It can help remove the wrinkles around the lips commonly seen after prosthetic rehabilitation of an overclosed stoma and with chronic smoking, prolonged sun exposure, and aging skin. In extreme cases, it can successfully remove superficial and moderate wrinkles, with results lasting roughly 2 years. Erbium laser treatments can turn back the clock significantly on skin tone, tightness, and texture. The Erbium YAG Laser has been introduced as the next step in laser resurfacing and offers the benefits of less pain during treatment and recovery along with significantly faster healing times than any other resurfacing laser! 61 used an Er:YAG laser to treat lesions in 20 patients who had at least one implant with moderate to advanced periimplantitis, for a total of 40 implants. 5.13). The Erbium YAG laser is manufactured by Continuum Biomedical. The Er:YAG 2940-nm and erbium, chromium–doped yttrium-scandium-gallium-garnet (Er,Cr:YSGG) 2780-nm instruments are free-running pulsed lasers that are most highly absorbed in water, followed by high absorption in hydroxyapatite and poor absorption in hemoglobin. Single pulse durations above 1 μsec often were associated with considerable thermal effects. Bone surgery applications have been found in oral surgery, dentistry, implant dentistry, and otolaryngology. The erbium:YAG laser is a 2940-nm ablative laser that targets intracellular water like the CO 2 laser does; however, its affinity for intracellular water is 10 times greater than that of carbon dioxide laser. It is pumped by flashlamp, and is also used in dermatology for removal of wrinkles, acne, scars, and pigmented lesions, agespots, sun-spots and freckles, complexion improvement and reducing stretch marks (parameters: 80 mJ, 5 or 10 ms length of pulse, 1 Hz). 13.84, 13.85) to decrease intraocular pressure in glaucoma patients, but the procedure was stopped due to the very high risk of intraocular infection (Jelínková et al., 2000). Candidates for Treatment. After 3 and 6 months the sites decontaminated with the laser showed more improvement than conventionally treated sites. Theoretically, the erbium laser absorption coefficient in water is 10 times higher than that for the CO2 (10,600-nm) and even higher than for the Nd:YAG (1064-nm) laser. Collagen shrinking is reduced with the erbium, resulting in decreased effect on rhytids. Degranulation and root debridement were effectively accomplished with the Er:YAG laser without major thermal damage and somewhat faster than with a curette. Candidates for Treatment Erbium laser treatments can turn back the clock significantly on skin tone, tightness, and texture. The Erbium YAG Laser has been introduced as the next step in laser resurfacing and offers the benefits of less pain during treatment and recovery along with significantly faster healing times than any other resurfacing laser! A laser works by emitting a wavelength of high energy light, which when focused on a certain skin condition creates heat and destroys diseased cells. Er:YAG laser treatment. The erbium treatment device emits an infrared light that measures from 1,064 to 2,940 nanometres in wavelength. Laser irradiation for all test groups was performed at an energy output on the laser control panel of 50 to 60 mJ/pulse, energy density of 10.5 J/cm2, and pulse repetition rate of 30 Hz, in the oblique contact mode at a 30-degree angle, in constant motion and for 45 sec for each application. Although some clinicians view the associated bleeding as a hindrance when working with these lasers, a benefit of this wavelength is almost complete absence of operative or postoperative discomfort. This greater affinity allows for a cleaner target cell ablation with less thermal collateral cell damage. Newman , JB, Lord, JL, Ash, K, McDaniel, DH. The laser emission occurs at 2940 nm. Erbium:YAG lasers utilize the chromophore water to cause the greatest amount of vaporization possible to effectively treat and remove unwanted skin blemishes, both superficial and deep. In analyzing the effect of lasers on cell proliferation to promote healing, at least one other study was conducted by Pourzarandian et al. From the second group of active media, Er:glass, generating the wavelength 1535 nm, has great importance. The gentle treatment provided by the Erbium YAG Laser guarantees minimal discomfort and a quick recovery period for the patient; this laser treatment works its magic with the removal of layer upon layer of skin. 2000; 26(2): 208–214(2000). Each of the 200-μsec pulses actually consists of a train of about 20 shorter pulses (typically 1 μsec long). The acronym LASER stands for light amplification by stimulated emission of radiation. The Erbium YAG laser is a high-powered device that produces energy that gently penetrates the skin. This laser is potentially useful for medical applications because this wavelength is attenuated by tissue, but at the same time it can easily be transmitted through fused silica fibers (see Chapter 4). Variable pulse erbium:YAG laser skin resurfacing of perioral rhytides and side-by-side comparison with carbon dioxide laser. There are several other solid-state lasers that are based on doped crystals, such as YAG (yttrium aluminum garnet) or YLF (yttrium lithium fluoride), and some are available commercially. Schwarz et al.61 used an Er:YAG laser to treat lesions in 20 patients who had at least one implant with moderate to advanced periimplantitis, for a total of 40 implants. The use of erbium lasers was cleared by the FDA for several areas of oral care: in 1997 for hard tissue treatment (enamel and dentin),136 in 1999 for soft tissues surgery and sulcular debridment,137 and in 2004 for osseous surgery.138,139, The erbium lasers are versatile and can be used for many different procedures in dentistry. The entire surface of the skin is removed to a variable depth (50 microns for a “mini-peel” or … The zone of thermal necrosis can be modified from 20-micron to 200-micron ablation based on the pulse width chosen. INITIA A powerful and versatile diode laser for virtually ‘pain-free’ hair removal on all skin types. Er:YAG lasers with the wavelength 2.9 μm have been used for laser resurfacing of human skin, treating of acne scarring, deep rhytides, and melasma. Lasers with infrared wavelength ranges such as long pulse Nd:YAG have been used in nonablative rejuvenation of skin with variable outcomes. 15, 17–19 This study prospectively evaluates 21 patients after controlled treatments with the EnYAG resurfacing laser. As with diode lasers, it must be emphasized that the results of procedures performed with one of the erbium wavelengths may not be extrapolated to the other wavelength. SmoothEye procedure is used to target volume through collagen induction. Apr 1 2003; 111(4): 1524–9; discussion 1530–2. The Ho: YAG laser has an emission wavelength of 2.1 ?m. Home Plast Reconstr Surg. Commonly used erbium YAG laser settings Typical settings employed for birthmarks, age spots and superficial skin ablation are wavelength 2940 nm, short pulse, laser output 2.5–5 J/cm 2, and pulse duration 250 microseconds. At the Laser & Skin Surgery Center of New York, we use the Erbium YAG to treat fine lines, acne scars, surgical scars, and some pigmentation irregularities. William T. McClellan MD, Brooke R. Seckel MD, FACS, in Plastic Surgery Secrets Plus (Second Edition), 2010. These properties enable Dr. Shah or one of his medical assistants to remove thin layers of aged and sun-damaged skin tissue with exquisite precision while protecting healthy surrounding tissue. Er:YAG laser emission on the basis of the absorption of radiation in water. So, the Er:YAG laser is very useful in dentistry, dermatology, urology, and bone surgery. 13.84. Erbium YAG laser treatment — codes and concepts. This however has not replaced the use of fractional CO2, which is still the gold standard today for treating acne scars. The erbium provides the laser activity in the crystal. Maruyama et al.199 compared erbium laser irradiation alone with irradiation followed by chemical and/or mechanical conditioning (using tetracycline, EDTA gel, or minocycline paste). One of the more interesting active materials from the first group is Er:YAG, due to the coincidence of its generated wavelength with the absorption peak of water (optical absorption > 3000 cm− 1 – see Fig. DermNet NZ does not provide an online consultation service. Fotona uses Er:YAG, a precise superficial laser peel that is able to remove some very thin layers of microns from the epidermis to reduce the appearance of fine lines, some tiny wrinkles, and pigmentation spots. It has been found that this dopant by itself is not sufficient to form a practical laser. With your help, we can update and expand the website. https://centerforplasticsurgeryatlanta.com/erbium-yag-laser-skin-resurfacing Two other dopants, such as thulium (Tm) and chromium (Cr), must be added to serve as sensitizers. Radiations with wavelengths in the first group are strongly absorbed by water because of atomic resonances; the active materials from the second group generate wavelengths which belong to (1.5 μm) or are very near (1.66 μm, 1.7 μm) a very useful part of the spectrum called the ‘eye safe’ region, which poses very little hazard to the human eye. Contact us to sponsor a DermNet newsletter. 13.85. This result suggests that this laser technique may be of therapeutic benefit for wound healing.197. Topics A–Z Because the result is rapid healing without scarring, this technique can be used to “resurface” the skin. The Er: YAG laser is a solid-state laser which is quite similar to the Nd: YAG laser, except that the impurity in the YAG crystal is the rare earth erbium (Er) rather than neodymium (Nd). Tissue studies show that these lasers remove very precise thin layers of skin or tissue with each pass (pulse). The two laser treatment groups each received two irradiation sessions—at 60 mJ/pulse and 10 Hz, 10 sec each, with 10-second intervals, 3 J/cm2 in group B, and at 100 mJ/pulse and 10 Hz, 10 sec each with 10-sec interval, 5 J/cm2, in group C. The tip was applied at a 45-degree angle, in standardized motion and with continuous water spray. The laser is passed over the skin, emitting pulses that last a millisecond. SmartXide Touch CO 2 The industry-leading CO2 laser by DEKA, delivering dramatic results in just one session. Br J Dermatol. To date, there have been no studies or peer-reviewed published reports of its effects or use in pocket therapy. The tissue is removed from the epidermis through vaporization, allowing for a … Melanin can only absorb wavelengths between about 300-1,000 nm, so CO 2 and Er:YAG do not directly cause the pigment issues. Copyright © 2021 Elsevier B.V. or its licensors or contributors. History of prior ionising radiation to the skin. YAG is abbreviated from: neodymium-doped yttrium aluminum garnet). The characteristic microstructures of the irradiated surface were fragile and could be removed by chemical or mechanical conditioning treatments. This could be considered as one of the important regulatory pathways to accelerate wound healing after Er:YAG laser irradiation.198 It can be concluded, therefore, that erbium laser light can be used not only to prepare root surfaces for the attachment of connective tissue fibers but also to promote wound healing of the periodontal soft tissues. Erbium lasers are systems in which the rare earth element Er3+ constitutes the active ion in a matrix such as YAG, YAP (yttrium aluminum perovskite), YLF (LiYF4), YSGG, and glass (Zharikov et al., 1975; From: Lasers for Medical Applications, 2013, J. Šulc, H. Jelínková, in Lasers for Medical Applications, 2013. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Solid-state lasers for medical applications, Laser-Assisted Nonsurgical Periodontal Therapy, Principles and Practice of Laser Dentistry, Principles and Practice of Laser Dentistry (Second Edition), Plastic Surgery Secrets Plus (Second Edition), Journal of the American Society for Mass Spectrometry, European Journal of Pharmaceutics and Biopharmaceutics, Efficient resonantly pumped eye-safe erbium laser (erbium doping, Lasing at the water absorption maximum (erbium doping, High water absorption, special fibers for delivery are available (, Large absorption in water, higher repetition rate than Er:YAG (, Material with large gain, possible diode pumping (Sulc, Dentistry, bone surgery, dermatology, ophthalmology. ResurFACE ® The award-winning ResurFACE® fractional Er: YAG laser delivers ablative treatments for dramatic skin rejuvenation results. Although similar in wavelength, these two erbium lasers are slightly different in absorption coefficient, extinction length, and other wavelength-dependent parameters. Erbium uses the YAG laser. Scleral laser surgery is rare. A cell-rich granulation tissue with fibroblasts and osteoblasts was predominant in 7-day specimens of an Er:YAG laser group. Robert A. Strauss, Kenneth S. Magid, in Esthetic Dentistry (Third Edition), 2015, The Er:YAG laser and the CO2 laser (using a high power, short pulse configuration such as “superpulsing”) can selectively remove the surface epidermis and the papillary dermis of the skin while leaving the underlying reticular dermis and adnexal (epithelial-based) structures. This allows internal wound vertical migration of epithelium as opposed to the adjacent basal cell horizontal migration normally seen. This laser is highly absorbed by the water containing tissues in the skin. The Er:YAG found its main application due to its generated wavelength and its optical absorption in water (> 3000 cm− 1). Erbium-doped yttrium-aluminum-garnet (Er:YAG) and erbium plus chromium–doped yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers (also referred to as erbium lasers or erbium family lasers) have wavelengths in the near-infrared zone of the spectrum, 2940 nm and 2780 to 2790 nm, respectively. Their attractiveness resides in the wavelengths generated. Erbium Laser Schwarz et al. A variety of laser wavelengths are useful for soft tissue procedures. Unlike Nd:YAG laser, the output of an Er:YAG laser is strongly absorbed by water. Designed to treat superficial and moderately deep lines and wrinkles on the face, the erbium laser is the latest advancement in laser rejuvenation with significant benefits over previous laser resurfacing options. 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